Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Psychiatry Reports
Published in: Current Psychiatry Reports 9/2016

01-09-2016 | Mood Disorders (MA Oquendo and MF Grunebaum, Section Editors)

Suicidal Behavior in Mood Disorders: Response to Pharmacological Treatment

Authors: Leonardo Tondo, Ross J. Baldessarini

Published in: Current Psychiatry Reports | Issue 9/2016

Login to get access

Abstract

Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with substantial evidence of preventive effects on suicidal behavior is long-term treatment with lithium. It is unclear whether this effect is specifically antisuicidal or reflects beneficial effects of lithium on depression, mood instability, and perhaps aggression and impulsivity. Antisuicidal effects of anticonvulsant mood stabilizers (carbamazepine, lamotrigine, valproate) appear to be less than with lithium. Further evaluation is needed for potential antisuicidal effects of atypical antipsychotics with growing evidence of efficacy in depression, particularly acute bipolar depression, while generally lacking risk of inducing agitation, mania, or mood instability. Short-term and long-term value and safety of antidepressants are relatively secure for unipolar depression but uncertain and poorly tested for bipolar depression; their effects on suicidal risk in unipolar depression may be age-dependent. Sedative anxiolytics are virtually unstudied as regards suicidal risks. Adequate management of suicidal risks in mood disorder patients requires comprehensive, clinically skillful monitoring and timely interventions.
Literature
1.
Hennen J, Baldessarini RJ. Reduced suicidal risk during treatment with clozapine: a meta-analysis. Schizophr Res. 2005;73:139–45.PubMedCrossRef
2.•
Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003;60:82–91. Controlled trial of clozapine vs. olanzapine for suicidal risk in schizophrenia.PubMedCrossRef
3.•
Baldessarini RJ, Tondo L, Davis P, Pompili M, Goodwin FK, Hennen J. Decreased suicidal risk during long-term lithium treatment: meta-analysis. Bipolar Disord. 2006;8:625–39. Meta-analysis of studies of lithium vs. suicidal risks.PubMedCrossRef
4.•
Tondo L, Baldessarini RJ. Suicide in bipolar disorder. In: Yildiz A, Nemeroff C, Ruiz P, editors. The Bipolar Book: History, Neurobiology, and Treatment. New York: Oxford University Press; 2015. p. 509–28. Book reviews bipolar disorder comprehensively.CrossRef
5.
Tondo L, Lepri B, Baldessarini RJ. Suicidal status during antidepressant treatment in 789 Sardinian patients with major affective disorder. Acta Psychiatr Scand. 2008;118:106–15.PubMedCrossRef
6.•
Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;293:2487–95. Epidemiology of suicide-related behaviors in the general population.PubMedCrossRef
7.
Nordstrom P, Samuelsson M, Åsberg M. Survival analysis of suicide risk after attempted suicide. Acta Psychiatr Scand. 1995;91:336–40.PubMedCrossRef
8.•
Tondo L, Baldessarini RJ. Suicidal risks among 2826 major affective disorder patients. Acta Psychiatr Scand. 2007;116:419–28. Systematic comparison of risks in bipolar I, II, and unipolar mood disorder patients.PubMedCrossRef
9.•
Tondo L, Baldessarini RJ. Reduction of suicidal behavior in bipolar disorder patients during long-term treatment with lithium. In: Koslow SH, Ruiz P, Nemeroff CB, editors. A concise guide to understanding suicide. Cambridge: Cambridge University Press; 2014. p. 217–28. Book reviews many aspects of suicide.CrossRef
10.•
Simon RI, Hales RE. Textbook of suicide assessment and management. 2nd ed. Washington, DC: American Psychiatric Press; 2012. Basic textbook on suicide.
11.•
Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry. 1998;173:11–53. Classic review of associations of suicide risk with specific psychiatric disorders.PubMedCrossRef
12.
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 5th revision (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
13.
Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM, et al. Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. Am J Psychiatry. 2013;170:31–42.PubMedCrossRef
14.•
Novick DM, Swartz HA, Frank E. Suicide attempts in bipolar I and bipolar II disorder: review and meta-analysis of the evidence. Bipolar Disord. 2010;12:1–9. Indicates special risks with mixed-states.PubMedPubMedCentralCrossRef
15.•
Tondo L, Pompili M, Forte A, Baldessarini RJ. Suicide attempts in bipolar disorders: comprehensive review of 101 reports. Acta Psychiatr Scand. 2016;133:174–86. Systematic review of the topic.PubMedCrossRef
16.
17.
Kaplan KJ, Harrow M, Clews K. The twenty-year trajectory of suicidal activity among post-hospital psychiatric men and women with mood disorders and schizophrenia. Arch Suicide Res 2016.
18.
Roy-Byrne PP, Post RM, Hambrick DD, Leverich GS, Rosoff AS. Suicide and course of illness in major affective disorder. J Affect Disord. 1988;15:1–8.PubMedCrossRef
19.•
Schaffer A, Isometsä ET, Tondo L, Moreno DH, Sinyor M, Kessing LV, et al. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: part I of a report of the International Society for bipolar disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry. 2015;49:785–802. Comprehensive review of suicide in bipolar.PubMedCrossRef
20.
Baldessarini RJ, Vieta E, Calabrese JR, Tohen M, Bowden CL. Bipolar depression: overview and commentary. Harv Rev Psychiatry. 2010;18:143–57.PubMedCrossRef
21.
Rihmer A, Gonda X, Balazs J, Faludi G. Importance of depressive mixed states in suicidal behaviour. Neuropsychopharmacol Hung. 2008;10:45–9.PubMed
22.
Saunders KE, Hawton K. Clinical assessment and crisis intervention for the suicidal bipolar disorder patient. Bipolar Disord. 2013;15:575–83.PubMedCrossRef
23.•
APA (American Psychiatric Association). Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 2003;160:1–60. A balanced and comprehensive overview.CrossRef
24.•
Goldsmith SK, Pellmar TC, Kleinman AM, Bunney Jr WE. Reducing suicide. Washington, DC: Institute of Medicine of the US National Academies of Science; 2002. Comprehensive, medically-oriented review of suicide.
25.
Weinger RD. Practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: Task Force Report of the American Psychiatric Association. 2nd ed. Washington, DC: American Psychiatric Press; 2002.
26.
27.
Ernst CL, Bird SA, Goldberg JF, Ghaemi SN. Prescription of psychotropic medications for patients discharged from a psychiatric emergency service. J Clin Psychiatry. 2010;67:720–6.CrossRef
28.
Baldessarini RJ, Salvatore P, Khalsa HM, Gebre-Medhin P, Imaz H, González-Pinto A, et al. Morbidity in 303 first-episode bipolar I disorder patients. Bipolar Disord. 2010;12:264–70.PubMedCrossRef
29.
De Dios C, Ezquiaga E, Garcia A, Soler B, Vieta E. Time spent with symptoms in a cohort of BD outpatients in Spain: prospective, 18-month follow-up study. J Affect Disord. 2010;125:74–81.PubMedCrossRef
30.•
Forte A, Baldessarini RJ, Tondo L, Vázquez GH, Pompili M, Girardi P. Long-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders. J Affect Disord. 2015;178:71–8. Meta-analytic review indicating high levels of unresolved depressive morbidity in treated bipolar I, II, and unipolar mood disorders.PubMedCrossRef
31.
Isometsä ET, Henriksson MM, Aro HM, Heikkinen ME, Kuoppasalmi KI, Lönnqvist JK. Suicide in major depression. Am J Psychiatry. 1994;151:530–6.PubMedCrossRef
32.
Sareen J, Isaak C, Katz LY, Bolton J, Enns MW, Stein MB. Promising strategies for advancement in knowledge of suicide risk factors and prevention. Am J Prev Med. 2014;47:S257–63.PubMedCrossRef
33.
Sheehan D, Giddens J. Suicidality: a roadmap for assessment and & treatment. Tampa: Harm Research Press; 2015.
34.
Brenner LA, Breshears RE, Betthauser LM, Bellon KK, Holman E, Harwood JE, et al. Implementation of a suicide nomenclature within two VA healthcare settings. J Clin Psychol Med Settings. 2011;18:116–28.PubMedCrossRef
35.
Crosby AE, Ortega LV, Melanson C. Self-directed violence surveillance: uniform definitions and recommended data elements. Version 1.0. Atlanta: Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Violence Prevention; 2011.
36.
FDA (US Food and Drug Administration). Guidance for Industry. Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials. U.S. Department of Health and Human Services, Food and Drug Administration Center for Drug Evaluation and Research (CDER); 2012. Accessible at: www.​fda.​gov/​downloads/​Drugs/​Guidances/​UCM225130.​pdf.
37.
Baldessarini RJ. Chemotherapy in psychiatry. 3rd ed. New York: Springer Press; 2013.CrossRef
38.
Khan A, Khan S, Kolts R, Brown WA. Suicide rates in clinical trials with SRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry. 2003;160:790–2.PubMedCrossRef
39.
Khan A, Khan SR, Hobus J, Faucett J, Mehra V, Giller EL, et al. Differential pattern of response in mood symptoms and suicide risk measures in severely ill depressed patients assigned to citalopram with placebo or citalopram combined with lithium: role of lithium levels. J Psychiatr Res. 2011;45:1489–96.PubMedCrossRef
40.•
Sim K, Lau KL, Sim J, Sum MY, Baldessarini RJ. Prevention of relapse and recurrence in adults with major depressive disorder: systematic review and meta-analyses of controlled trials. Intl J Neuropsychopharmacol. 2015;19. Systematic review of long-term treatment trials in major depression.
41.
Søndergård L, Kvist K, Lopez AG, Andersen PK, Kessing LV. Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995–1999. Acta Psychiatr Scand. 2006;114:168–76.PubMedCrossRef
42.
Tondo L, Isacsson G, Baldessarini RJ. Suicide in bipolar disorder: risk and prevention. CNS Drugs. 2003;17:491–511.PubMedCrossRef
43.•
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for bipolar disorders (ISBD) collaborative update for the management of patients with bipolar disorder. Bipolar Disord. 2013;15:1–44. Expert overview of treatments for bipolar disorder.PubMedCrossRef
44.
Ghaemi SN, Hsu DJ, Soldani F, Goodwin FK. Antidepressants in BD: the case for caution. Bipolar Disord. 2003;5:421–33.PubMedCrossRef
45.•
Pacchiarotti I, Bond DJ, Baldessarini RJ, Nolen WA, Grunze H, Licht RW, et al. International Society for bipolar disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry. 2013;170:1249–62. Comprehensive review of the value and risks of antidepressant treatment in bipolar disorder.PubMedPubMedCentralCrossRef
46.
Akiskal HS, Benazzi F, Perugi G, Rihmer Z. Agitated “unipolar” depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy. J Affect Disord. 2005;85:245–58.PubMedCrossRef
47.
Baldessarini RJ, Faedda GL, Hennen J. Risk of mania with serotonin reuptake inhibitors vs. tricyclic antidepressants in children, adolescents and young adults. Arch Pediatr Adolesc Med. 2005;159:298–9.PubMedCrossRef
48.•
Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ. 2009;180:291–7. Systematic review of large databases.PubMedPubMedCentralCrossRef
49.
Koukopoulos A, Koukopoulos A. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am. 1999;22:547–64
50.
Maj M, Pirozzi R, Magliano L, Fiorillo A, Bartoli L. Agitated “unipolar” major depression: prevalence, phenomenology, and outcome. J Clin Psychiatry. 2006;67:712–9.
51.
Popovic D, Vieta E, Azorin JM, Angst J, Bowden CL,Mosolov S, et al. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study. Bipolar Disord. 2015;17:795–803.
52.
Tondo L, Baldessarini RJ, Hennen J, Minnai GP, Salis P, Scamonatti L, et al. Suicide attempts in major affective disorder patients with comorbid substance use disorders. J Clin Psychiatry. 1999;60:63–9.
53.
Acharya N, Rosen AS, Polzer JP, D’Souza DN, Perahia DG, Cavazzoni PA, et al. Duloxetine: meta-analyses of suicidal behaviors and ideation in clinical trials for major depressive disorder. J Clin Psychopharmacol. 2006;26:587–94.
54.•
Baldessarini RJ, Tondo L, Strombom I, Dominguez S, Fawcett J, Oquendo M, et al. Analysis of ecological studies of relationships between antidepressant utilization and suicidal risk. Harv Rev Psychiatry. 2007;15:133–45. Critical overview of evidence concerning antidepressant treatment and suicidal risks.PubMedCrossRef
55.
Beasley Jr CM, Dornseif BE, Bosomworth JC, Sayler ME, Rampey Jr AH, Heilgenstein JH, et al. Fluoxetine and suicide: meta-analysis of controlled trials of treatment for depression. BMJ. 1991;303:685–92.PubMedPubMedCentralCrossRef
56.•
Hammad TA, Laughren TP, Racoosin JA. Suicide rates in short-term randomized controlled trials of newer antidepressants. J Clin Psychopharmacol. 2006;26:203–7. FDA post-hoc review of antidepressants and risks of suicidal thoughts and behaviors.PubMedCrossRef
57.
Tollefson GD, Rampey Jr AH, Beasley Jr CM, Enas GG, Potvin JH. Absence of a relationship between adverse events and suicidality during pharmacotherapy for depression. J Clin Psychopharmacol. 1994;14:163–9.PubMed
58.
Zisook S, Trivedi MH, Warden D, Lebowitz B, Thase ME, Stewart JW, et al. Clinical correlates of the worsening or emergence of suicidal ideation during SSRI treatment of depression. J Affect Disord. 2009;117:63–73.PubMedCrossRef
59.
Reseland S, Bray I, Gunnell D. Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries. Br J Psychiatry. 2006;188:354–8.PubMedCrossRef
60.
Möller HJ. Antidepressants: controversies about their efficacy in depression, their effect on suicidality and their place in a complex psychiatric treatment approach. World J Biol Psychiatry. 2009;10:180–95.PubMedCrossRef
61.
Valuck RJ, Libby AM, Anderson HD, Allen RR, Strombom I, Marangell LB, et al. Comparison of antidepressant classes and the risk and time course of suicide attempts in adults: propensity matched, retrospective cohort study. Br J Psychiatry. 2016;208:271–9.PubMedCrossRef
62.
Baldessarini RJ, Lau WK, Sim J, Sum MY, Sim K. Suicidal risks in reports of long-term treatment trials for major depressive disorder. Int J Neuropsychopharm 2015.
63.
Braun C, Bschor T, Franklin J, Baethge C. Suicides and suicide attempts during long-term treatment with antidepressants: meta-analysis of 29 placebo-controlled studies including 6934 patients with major depressive disorder. Psychother Psychosom. 2016;85:171–9.PubMedCrossRef
64.
Khan A, Warner HA, Brown WA. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: analysis of the FDA database. Arch Gen Psychiatry. 2000;57:311–7.PubMedCrossRef
65.•
66.
Wise J. Antidepressants may double risk of suicide and aggression in children, study finds. BMJ. 2016;352:i545.PubMedCrossRef
67.
Yerevanian BI, Choi YM. Impact of psychotropic drugs on suicide and suicidal behaviors. Bipolar Disord. 2013;15:594–621.PubMedCrossRef
68.
Gaertner I, Gilot C, Heidrich P, Gaertner HJ. Case control study on psychopharmacotherapy before suicide committed by 61 psychiatric inpatients. Pharmacopsychiatry. 2002;35:37–43.PubMedCrossRef
69.
Shih HI, Lin MC, Lin CC, Hsu HC, Lee HL, Chi CH, et al. Benzodiazepine therapy in psychiatric outpatients is associated with deliberate self-poisoning events at emergency departments—a population-based nested case-control study. Psychopharmacology (Berlin). 2013;229:665–71.CrossRef
70.
Sun Y, Lin CC, Lu CJ, Hsu CY, Kao CH. Association between zolpidem and suicide: a nationwide population-based, case-control study. Mayo Clin Proc. 2016;91:308–15.PubMedCrossRef
71.
Khan A, Khan SR, Leventhal RM, Brown WA. Symptom reduction and suicide risk among patients treated with placebo in antipsychotic clinical trials: an analysis of the Food and Drug Administration database. Am J Psychiatry. 2001;158:1449–54.PubMedCrossRef
72.
Tiihonen J, Wahlbeck K, Lönnqvist J, Klaukka T, Ioannidis JP, Volavka J, et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalization due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ. 2006;333:224–9.PubMedPubMedCentralCrossRef
73.
Haukka J, Tiihonen J, Härkänen T, Lönnqvist J. Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia. Pharmacoepidemiol Drug Saf. 2008;17:686–96.PubMedCrossRef
74.
Ahearn EP, Chen P, Hertzberg M, Cornette M, Suvalsky L, Cooley-Olson D, et al. Suicide attempts in veterans with BD during treatment with lithium, divalproex, and atypical antipsychotics. J Affect Disord. 2013;145:77–82.PubMedCrossRef
75.
Vázquez GH, Tondo L, Undurraga J, Baldessarini RJ. Overview of antidepressant treatment in bipolar depression: critical commentary. Int J Neuropsychopharmacol. 2013;16:1673–85.PubMedCrossRef
76.
Post RM. Treatment of bipolar depression: evolving recommendations. Psychiatr Clin North Am. 2016;39:11–33.PubMedCrossRef
77.•
Fornaro M, Stubbs B, De Berardis D, Perna G, Valchera A, Veronese N, et al. Atypical antipsychotics in the treatment of acute bipolar depression with mixed features: systematic review and exploratory meta-analysis of placebo-controlled clinical trials. Int J Mol Sci. 2016;17:241–54. Review of emerging value of atypical antipsychotics in mood disorders.PubMedPubMedCentralCrossRef
78.
Ifteni P, Correll CU, Nielsen J, Burtea V, Kane JM, Manu P. Rapid clozapine titration in treatment-refractory BD. J Affect Disord. 2014;166:168–72.PubMedCrossRef
79.•
Li XB, Tang YL, Wang CY, de Leon J. Clozapine for treatment-resistant bipolar disorder: systematic review. Bipolar Disord. 2015;17:235–47. Overview on clozapine vs. suicide.PubMedCrossRef
80.
Ciapparelli A, Dell’Osso L, Pini S, Chiavacci MC, Fenzi M, Cassano GB. Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic BD: a 24-month naturalistic study. J Clin Psychiatry. 2000;61:329–34.PubMedCrossRef
81.
Poo SX, Agius M. Atypical antipsychotics in adult bipolar disorder: current evidence and updates in the NICE guidelines. Psychiatr Danub. 2014;26 Suppl 1:322–9.PubMed
82.
Ulcickas-Yood M, Delorenze G, Quesenberry Jr CP, Tsai AL, Phillips S, Willey VJ, et al. Epidemiologic study of aripiprazole use and the incidence of suicide events. Pharmacoepidemiol Drug Saf. 2010;19:1124–30.PubMedCrossRef
83.
Kiviniemi M, Suvisaar J, Koivumaa-Honkanen H, Häkkinen U, Isohanni M, Hakko H. Antipsychotics and mortality in first-onset schizophrenia: prospective Finnish register study with 5-year follow-up. Schizophr Res. 2013;150:274–80.PubMedCrossRef
84.
Reutfors J, Bahmanyar S, Jönsson EG, Brandt L, Bodén R, Ekbom A, et al. Medication and suicide risk in schizophrenia: a nested case-control study. Schizophr Res. 2013;150:416–20.CrossRefPubMed
85.
Toffol E, Hätönen T, Tanskanen A, Lönnqvist J, Wahlbeck K, Joffe G, et al. Lithium is associated with decrease in all-cause and suicide mortality in high-risk bipolar patients: a nationwide registry-based prospective cohort study. J Affect Disord. 2015;183:159–65.PubMedCrossRef
86.
Crocq MA, Naber D, Lader MH, Thibaut F, Drici M, Everitt B, et al. Suicide attempts in a prospective cohort of patients with schizophrenia treated with sertindole or risperidone. Eur Neuropsychopharmacol. 2010;20:829–38.PubMedCrossRef
87.
88.
Thomas SH, Drici MD, Hall GC, Crocq MA, Everitt B, Lader MH, et al. Safety of sertindole versus risperidone in schizophrenia: principal results of the sertindole cohort prospective study (SCoP). Acta Psychiatr Scand. 2010;122:345–55.PubMedCrossRef
89.
Barak Y, Mirecki I, Knobler HY, Natan Z, Aizenberg D. Suicidality and second generation antipsychotics in schizophrenia patients: a case-controlled retrospective study during a 5-year period. Psychopharmacology (Berlin). 2004;175:215–9.CrossRef
90.
Reeves H, Batra S, May RS, Zhang R, Dahl DC, Li X. Efficacy of risperidone augmentation to antidepressants in the management of suicidality in major depressive disorder: randomized, double-blind, placebo-controlled pilot study. J Clin Psychiatry. 2008;69:1228–36.PubMedCrossRef
91.
Gentile S. Adverse effects associated with second-generation antipsychotic long-acting injection treatment: a comprehensive systematic review. Pharmacotherapy. 2013;33:1087–106.PubMedCrossRef
92.
Houston JP, Ahl J, Meyers AL, Kaiser CJ, Tohen M, Baldessarini RJ. Reduced suicidal ideation in bipolar I disorder mixed-episode patients in a placebo-controlled trial of olanzapine combined with lithium or divalproex. J Clin Psychiatry. 2006;67:1246–52.PubMedCrossRef
93.
Herings RM, Erkens JA. Increased suicide attempt rate among patients interrupting use of atypical antipsychotics. Pharmacoepidemiol Drug Saf. 2003;12:423–4.PubMedCrossRef
94.
Seemüller F, Lewitzka U, Bauer M, Meyer S, Musil R, Schennach R, et al. Relationship of akathisia with treatment emergent suicidality among patients with first-episode schizophrenia treated with haloperidol or risperidone. Pharmacopsychiatry. 2012;45:292–6.PubMedCrossRef
95.
Seemüller F, Schennach R, Mayr A, Musil R, Jäger M, Maier W, et al. Akathisia and suicidal ideation in first-episode schizophrenia. J Clin Psychopharmacol. 2012;32:694–8.PubMedCrossRef
96.•
Oquendo MA, Galfalvy HC, Currier D, Grunebaum MF, Sher L, Sullivan GM, et al. Treatment of suicide attempters with bipolar disorder: randomized clinical trial comparing lithium and valproate in the prevention of suicidal behavior. Am J Psychiatry. 2011;168:1050–6. Rare controlled trial to test for antisuicidal effects.PubMedPubMedCentralCrossRef
97.
Søndergård L, Lopez AG, Andersen PK, Kessing LV. Mood-stabilizing pharmacological treatment in bipolar disorders and risk of suicide. Bipolar Disord. 2008;10:87–94.PubMedCrossRef
98.
Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in BD during treatment with lithium and divalproex. JAMA. 2003;290:1467–73.PubMedCrossRef
99.
Thies-Flechtner K, Müller-Oerlinghausen B, Seibert W, Walther A, Greil W. Effect of prophylactic treatment on suicide risk in patients with major affective disorders: data from a randomized prospective trial. Pharmacopsychiatry. 1996;29:103–7.PubMedCrossRef
100.•
Hayes JF, Pitman A, Marston L, Walters K, Geddes JR, King M, Osborn DP. Self-harm, unintentional injury, and suicide in bipolar disorder during maintenance mood stabilizer treatment: UK population-based electronic health records study. JAMA Psychiatr. 2016. Supports an antisuicidal effect of lithium over that of other mood-stabilizers.
101.
Baldessarini RJ, Tondo L. Suicidal risks during treatment of bipolar disorder patients with lithium versus anticonvulsants. Pharmacopsychiatry. 2009;42:72–5.PubMedCrossRef
102.
Yerevanian BI, Koek RJ, Mintz J. Bipolar pharmacotherapy and suicidal behavior. Part I: lithium, divalproex and carbamazepine. J Affect Disord. 2007;103:5–11.PubMedCrossRef
103.
104.
Ferrer P, Ballarín E, Sabaté M, Vidal X, Rottenkolber M, Amelio J, et al. Antiepileptic drugs and suicide: a systematic review of adverse effect. Neuroepidemiology. 2014;42:107–20.PubMedCrossRef
105.
Fountoulakis KN, Gonda X, Baghai TC, Baldwin DS, Bauer M, Blier P, et al. Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy. Int J Psychiatry Clin Pract. 2015;19:158–67.PubMed
106.
Gibbons RD, Hur K, Brown CH, Mann JJ. Relationship between antiepileptic drugs and suicide attempts in patients with BD. Arch Gen Psychiatry. 2009;66:1354–60.PubMedPubMedCentralCrossRef
107.
Mula M, Kanner AM, Schmitz B, Schachter S. Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology. Epilepsia. 2013;54:199–203.PubMedCrossRef
108.
Rissanen I, Jääskeläinen E, Isohanni M, Koponen H, Ansakorpi H, Miettunen J. Use of antiepileptic or benzodiazepine medication and suicidal ideation—the Northern Finland Birth Cohort 1966. Epilepsy Behav. 2015;46:198–204.PubMedCrossRef
109.
Siamouli M, Samara M, Fountoulakis KN. Is antiepileptic-induced suicidality a data-based class effect or an exaggeration? A comment on the literature. Harv Rev Psychiatry. 2014;22:379–81.PubMedCrossRef
110.
Smith EG, Søndergård L, Lopez AG, Andersen PK, Kessing LV. Association between consistent purchase of anticonvulsants or lithium and suicide risk: longitudinal cohort study from Denmark, 1995–2001. J Affect Disord. 2009;117:162–7.PubMedCrossRef
111.
Smith EG, Austin KL, Kim HM, Miller DR, Eisen SV, Christiansen CL, et al. Suicide risk in Veterans Health Administration patients with mental health diagnoses initiating lithium or valproate: historical prospective cohort study. BMC Psychiatry. 2014;14:357–88.PubMedPubMedCentralCrossRef
112.
Angst J, Angst F, Gerber-Werder R, Gamma A. Suicide in 406 mood-disorder patients with and without long-term medication: 40 to 44 years’ follow-up. Arch Suicide Res. 2005;9:279–300.PubMedCrossRef
113.
114.•
Müller-Oerlinghausen B, Ahrens B, Felber W. Suicide-preventive and mortality-reducing effect of lithium. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry. London: Informa Healthcare; 2006. p. 79–192. In a comprehensive textbook on lithium.
115.
Marangell LB, Dennehy EB, Wisniewski SR, Bauer MS, Miyahara S, Allen MH, et al. Case-control analyses of the impact of pharmacotherapy on prospectively observed suicide attempts and completed suicides in bipolar disorder. J Clin Psychiatry. 2008;69:916–22.
116.
Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013;346:f3646.PubMedCrossRef
117.•
Tondo L, Hennen J, Baldessarini RJ. Reduced suicide risk with long-term lithium treatment in major affective illness: meta-analysis. Acta Psychiatr Scand. 2001;104:163–72. Early review of the evidence.PubMedCrossRef
118.
Lauterbach E, Felber W, Müller-Oerlinghausen B, Ahrens R, Brinisch T, Meyer T, et al. Adjunctive lithium treatment in the prevention of suicidal behavior in depressive disorders: randomized, placebo-controlled, 1-year trial. Acta Psychiatr Scand. 2008;118:469–79.PubMedCrossRef
119.
Tondo L, Baldessarini RJ, Hennen J, Floris G, Silvetti F, Tohen M. Lithium treatment and risk of suicidal behavior in BD patients. J Clin Psychiatry. 1998;59:405–14.PubMedCrossRef
120.
Guzzetta F, Tondo L, Centorrino F, Baldessarini RJ. Lithium treatment reduces suicide risk in recurrent major depressive disorder. J Clin Psychiatry. 2007;68:380–3.PubMedCrossRef
121.•
Lewitzka U, Bauer M, Felber W, Müller-Oerlinghausen B. Antisuicidal effect of lithium: current state of research and its clinical implications for the long-term treatment of affective disorders. Nervenarzt. 2013;84:294–306. Overview on lithium vs. suicide.PubMedCrossRef
122.
Tondo L, Albert MJ, Baldessarini RJ. Suicide rates in relation to health-care access in the United States: an ecological study. J Clin Psychiatry. 2006;67:517–23.PubMedCrossRef
123.
Barraclough B. Suicide prevention, recurrent affective disorder and lithium. Br J Psychiatry. 1972;121:391–2.PubMedCrossRef
124.
Bschor T, Bauer M. Efficacy and mechanisms of action of lithium augmentation in refractory major depression. Curr Pharm Des. 2006;12:2985–92.PubMedCrossRef
125.
Coppen A, Farmer R. Suicide mortality in patients on lithium maintenance therapy. J Affect Disord. 1998;50:261–7.PubMedCrossRef
126.
Manchia M, Hajek T, O’Donovan C, Deiana V, Chillotti C, Ruzickova M, et al. Genetic risk of suicidal behavior in bipolar spectrum disorder: analysis of 737 pedigrees. Bipolar Disord. 2013;15:496–506.PubMedCrossRef
127.•
Müller-Oerlinghausen B, Lewitzka U. Lithium reduces pathological aggression and suicidality: mini-review. Neuropsychobiology. 2010;62:43–9. Supports an antisuicidal effect of lithium independent of mood-stabilization.PubMedCrossRef
128.
Kovacsics CE, Gottesman II, Gould TD. Lithium’s antisuicidal efficacy: elucidation of neurobiological targets using endophenotype strategies. Annu Rev Pharmacol Toxicol. 2009;49:175–98. 123.
Metadata
Title
Suicidal Behavior in Mood Disorders: Response to Pharmacological Treatment
Authors
Leonardo Tondo
Ross J. Baldessarini
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 9/2016
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-016-0715-0

Other articles of this Issue 9/2016

Current Psychiatry Reports 9/2016 Go to the issue

Geriatric Disorders (W McDonald, Section Editor)

The Impact of Traumatic Brain Injury on the Aging Brain

Erratum

Erratum to: Combining Pharmacological and Psychological Treatments for Binge Eating Disorder: Current Status, Limitations, and Future Directions

Anxiety Disorders (A Pelissolo, Section Editor)

Cognitive Dysfunction in Obsessive-Compulsive Disorder

Child and Family Disaster Psychiatry (B Pfefferbaum, Section Editor)

Children’s Mental Health in the Context of Terrorist Attacks, Ongoing Threats, and Possibilities of Future Terrorism

Geriatric Disorders (W McDonald, Section Editor)

Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities

Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)

The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers